Q    I have great concerns over your health bill.  One of the ladies  in admissions over there whom I was talking with the other week, started  -- she’s from England, and her family is still in England.
 
   THE PRESIDENT:  Right.
 
   Q    And she was explaining to us how -- telling us what we had to  look forward to here.  Her sister worked as a nurse in the same hospital  for 20 years.  She was 55.  She was told she needed open-heart  surgery.  She was put on a 10-year waiting list.  Three years later, she  had a major heart attack and they were forced to give her that surgery  that she needed.
 
   I realize you’re saying the 26-year-olds will have health insurance --  they don’t have to worry about that.  My mother always told me the  older you get, the faster time goes.  And when she said that to me years  back, I thought she was crazy.
 
   THE PRESIDENT:  Yes, I’ve noticed this, too.  (Laughter.)
 
   Q    Yes.  And these 26-year-olds in a heartbeat are going to be 50,  55.  When you’re young, you’re supposed to be able to work hard for what  you want.  You build up your income.  You further yourself so you can  retire and have peace of mind.  It’s hard to -- I can’t fathom now how  can you be excited in your youth when you have to save, save, save just  to protect yourself health insurance-wise when you reach our age.
 
   THE PRESIDENT:  Let me ask you a question, though.  I mean, because  you said you’re worried about my health reform bill, and the nurse said,  here’s what you have to look forward to.  Is your mom on Medicare?
 
   Q    Yes.
 
   THE PRESIDENT:  So there’s nothing in our health reform bill that is  going to impact whether your mom can get heart surgery if she needed  it.  We didn’t change the core Medicare program.  So unless there’s  something specific that you’re worried about --
 
   Q    Medicare doesn’t start until you’re 65.
 
   THE PRESIDENT:  No, no, I understand.
 
   Q    I’m talking about 50, 55 years old. 
 
   THE PRESIDENT:  All right, so if you’re not on Medicare --
 
   Q    Yes, right.
 
   THE PRESIDENT:  And do you have health insurance?
 
   Q    Yes.  Right now, yes.
 
   THE PRESIDENT:  So there’s nothing in the bill that says you have to  change the health insurance that you’ve got right now.  I just want to  identify what your worry is, because I want to say you shouldn’t be  worried about it.  But what is it that you think might happen to your  health insurance as a consequence of health care reform?
 
   Q    Okay, what I’m concerned about is say if my -- just say if my husband got laid off.  Say we had no health care.
 
   THE PRESIDENT:  You had no health insurance, okay?  Now, right now  before reform, if you had no health insurance, you’d just be out of  luck, okay?
 
   Q    And then we’d get the government-run health insurance, right?  Is that what you’re saying?
 
   THE PRESIDENT:  No, here’s the way it would work.  So let me just kind  of map it out for you.  If you are already getting health insurance on  your job, then that doesn’t change.  Health insurance reform was passed  six months ago.  I don’t know if anybody here has gotten a letter from  their employer saying you now have to go into government-run health care  because we can’t provide you health insurance anymore.  I mean, that  hasn’t happened, right?
 
   So you’re keeping the health insurance that you had through your job.   And the majority of people still get health insurance through your  job. 
 
   The only changes we’ve made on people’s health insurance who already  have it was to make it a little more secure by saying there are certain  things insurance companies can’t do -- a patient’s bill of rights,  basically.
 
   So insurance companies can no longer drop your coverage when you get  sick, which was happening.  Sometimes there were some insurance  companies who were going through your policy when you got sick to see if  you had filled out the form wrong, you hadn’t listed some infection  that they might call a preexisting condition, et cetera -- a bunch of  fine print that led to people not having health insurance.  So that was  one thing that we said. 
 
   We said also you can keep kids on your health insurance till they’re  26; that children with preexisting conditions had to be covered under  health insurance.
 
   So there were a handful of things that we said insurance companies  have to do, just as good business practices to protect consumers.  But  otherwise you can stay on your employer’s health care.  So that’s if you  have health insurance.
 
   The other thing that we did was we said if you’re a lot of people who  don’t have health insurance, it’s because they work for small  businesses, who have trouble affording health insurance, because they’re  not part of a big pool -- they’re not like a big company that has  thousands of employees and they can negotiate because the insurance  companies really want their business -- so what we said was let’s  provide tax breaks to small businesses so they can -- they’re more  likely to buy health insurance for their employees.  And right now about  4 million businesses across the country are now getting a tax break, a  tax credit, if they provide health insurance for their employees, that  can save them tens of thousands of dollars.  So that’s the second thing.
 
   And the third thing we said was, okay, if you don’t have health  insurance -- let’s just say your job doesn’t offer you health insurance,  or you lose your job -- then what we’re going to set up is what’s  called an exchange, which is basically a big pool -- you become part of  this big group of people, just like as if you were working for a big  company or a big university like Drake.  You become part of this pool,  and you’ll be able to buy your own insurance through this pool, but the  rates will be lower and you’ll get a better deal because you’ve got the  bargaining power of these thousands or millions of people who you’re  buying it with.  You’ll still have a choice of plans.  You’ll have a  choice of BlueCross or you’ll have a choice of this plan or that plan,  but you’ll be buying it through a pool.  And if you can’t afford it,  then we’ll provide you some subsidies to see if we can help you buy it,  so make it affordable.
 
   So that’s essentially what health reform is about.  Now, what that  means is, is that you’re not going to be forced to buy a  “government-run” health care plan.  The only thing that we have said is,  is that if you can afford to get health care and you’re not getting  health care, well, that’s a problem because that means when you get sick  and you have to go the emergency room, everybody else here has to pay  for it.  And that’s not fair.
 
   So we’ve said if you can afford to get health care, we’re going to  make sure that you can afford it, but you’ve got to have some basic  coverage so that we’re not subsidizing -- everybody else isn’t paying an  extra thousand dollars on their premiums to cover you.